First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists
Authors: Sol Carriazo, Alberto Ortiz, Beatriz Fernandez-Fernandez
Journal: Annals of Internal Medicine (2023)

LettersApril 2023First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor AgonistsSol Carriazo, MD, Alberto Ortiz, MD, PhD, Beatriz Fernandez-Fernandez, MD, PhDSol Carriazo, MDDepartment of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, SpainSearch for more papers by this author, Alberto Ortiz, MD, PhDDepartment of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, SpainSearch for more papers by this author, Beatriz Fernandez-Fernandez, MD, PhDDepartment of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, SpainSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Choi and colleagues (1) concluded, “As first-line agents, [sodium–glucose cotransporter-2 {SGLT2}] inhibitors and [glucagon-like peptide-1 {GLP1}] receptor agonists would improve type 2 diabetes outcomes, but their costs would need to fall by at least 70% to be cost-effective.” However, their analysis has 2 major weaknesses.Both the medication treatment algorithms (Figure 1 of Choi and colleagues' article) and the meta-analytic effects of SGLT2 inhibitors on outcomes (Table 1 of their article) unfortunately seem outdated. Therapy with SGLT2 inhibitors may and should be initiated in patients with type 2 diabetes, including those who have chronic kidney disease (CKD) ...References1. Choi JG, Winn AN, Skandari MR, et al. First-line therapy for type 2 diabetes with sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. A cost-effectiveness study. Ann Intern Med. 2022;175:1392-400. [PMID: 36191315] doi:10.7326/M21-2941 LinkGoogle Scholar2. de Boer IH, Khunti K, Sadusky T, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45:3075-90. [PMID: 36189689] doi:10.2337/dci22-0027 CrossrefMedlineGoogle Scholar3. Alexander JT, Staab EM, Wan W, et al. Longer-term benefits and risks of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes: a systematic review and meta-analysis. J Gen Intern Med. 2022;37:439-48. [PMID: 34850334] doi:10.1007/s11606-021-07227-0 CrossrefMedlineGoogle Scholar4. Nuffield Department of Population Health Renal Studies Group. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet. 2022;400:1788-801. [PMID: 36351458] doi:10.1016/S0140-6736(22)02074-8 CrossrefMedlineGoogle Scholar5. ERA-EDTA Council. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant. 2021;36:87-94. [PMID: 33340043] doi:10.1093/ndt/gfaa314 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sol Carriazo, MD; Alberto Ortiz, MD, PhD; Beatriz Fernandez-Fernandez, MD, PhDAffiliations: Department of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz UAM, Madrid, SpainDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0005. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFirst-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists Jin G. Choi , Aaron N. Winn , M. Reza Skandari , Melissa I. Franco , Erin M. Staab , Jason Alexander , Wen Wan , Mengqi Zhu , Elbert S. Huang , Louis Philipson , and Neda Laiteerapong Metrics April 2023Volume 176, Issue 4KeywordsAtherosclerotic cardiovascular diseaseDiabetes mellitusHbA1cLife expectancyMarkov modelsMedical risk factorsQuality adjusted life expectancyQuality adjusted life yearsQuality of lifeType 2 diabetes ePublished: 18 April 2023 Issue Published: April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...